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Part III Miss Hira Jabeen ANMC Technique of treatment: Preparation Of Apparatus: Source of current: a cell battery or apparatus which uses the main supply Testing of apparatus: Leads attached to terminals not touching each other in a bowl of tap water Current slowly turned up and make sure regulation of current is even Tap water is used because it has a fairly high resistance and so the control can be turned well up without passing excess current through the milliamperemeter. The polarity can be checked by observing the bubbles from the cathode. Operator may test the current on herself Pads At least half an inch in thickness In order that the chemicals formed at the electrodes shall not soak through to the skin. (Sixteen thicknesses of lint) Evenly folded with no creases or raw edges Pads are soaked in warm 1 percent saline Half an inch smaller all round than the pads With rounded corners PREPARATION OF THE PATIENT Skin sensations must be tested at the first attendance To ensure that the patient will be able to detect any concentration of current The test may be made with a blunt object and cotton wool Skin is washed and abrasions protected APPLICATION OF PADS AND ELECTRODES Skin moistened with saline and electropads are applied No metal comes in contact with the skin. Held in position with the bandages Bandage the leads away from the skin If the surface is irregular, hollows may be padded with the wool soaked in saline APPLICATION OF CURRENT PATIENT EDUCATION: The patient is warned that she will experience a pricking sensation as the current is increased, which will gradually pass off and be replaced by a feeling of warmth, also that she must report any discomfort or concentration of current. Current is turned up slowly, taking about 5 minutes to reach the maximum, The pricking sensations experienced at this stage are thought to be due to stimulation of sensory nerve endings at the basis of hair follicles Due to the continuous passage of current, ions enter the epidermis and reduce its resistance, so that the distribution of current becomes more even. The pricking passes off and the sensation of warmth is due to increased blood supply. Current slowly turned up Prickling sensation continuo us passage of current reduce epider mis resista nce More current erythem a Conclusion of the treatment the current is reduced slowly and turned off. Skin is washed to remove any chemicals Dried and powdered or a soothing cream At the first attendance =less current, and for a shorter time A record should be kept of: the size and position of the pads, the intensity of the current, the duration of the treatment and the skin reaction at each attendance. TREATMENT WITH BATHS PRECAUTIONS Danger of burn is rather less as any chemical which may be formed dissolve in the water and so are diluted. Rings ,chains any metal etc, must be removed The patient warned not to touch any electrode. Breaks in the skin are protected by petroleum jelly, as they would cause discomfort due to concentration of ions. Cont.. The danger of shock is greater than with the pads and electrodes Patient should be warned not to take the limb out of the bath during treatment, as this would break the circuit and cause a shock Control is turned up and down very slowly USES OF THE BATH TREATMENT For widespread effect Increasing the blood supply to a limb For an irregular area such as the hand or the foot Not suitable for the treatment of the swollen areas as the limb must be dependent DANGER AND PRECAUTIONS ELECTRIC SHOCK Electric shock is one of the dangers associated with the application of the constant D.C. The precautions that should be taken. ELECTROLYTIC BURNS Burns produced by the constant D.C. are electrolyte or chemical burns Causes : 1. Metal in contact with the tissues 2. Due to a break in the skin to the presence of undissolved salts on the pad 3. Pads of uneven thickness or with creases or with raw edges of pads that are unevenly damp 4. Electrode being bent, cracked or much smaller than the pads 5. Pads being too close together 6. Pads are too thin for the intensity and duration of the treatment 7. Application of liniment 8. Impaired sensation Healing of electrolytic burn Grey spot surrounded by the reddened area Healing is slow and by second intention Area should be kept dry and clean Protected by dry sterile gauze GALVANIC RASH Individuals with sensitive skins are liable to develop rash on the skin Type of rash varies in different cases; It may be red, like nettle rash, or small white spots or minute blisters may appear. Skin should be washed and soothing cream applied. Presence of the rash should be reported to the medical officer GIDDINESS If the current is passed through the region of the semicircular canals When the intensity is being varied e.g. In treatment of the ear or mandibular joint Patient must be fully supported Current increased and decreased very slowly Operator at hand throughout the treatment CONTRAINDICATIONS Anesthetic areas of the skin metal embedded in the tissues breaks in the skin Any Question? THE END